New research from the University of Liverpool, published today in PLOS Medicine, has calculated the overall effectiveness of the National Health Service (NHS) Health Check programme in Liverpool, a city still grappling with high levels of deprivation and cardiovascular disease.
Aiming to contribute to the prevention of cardiovascular disease, the NHS Health Check programme has been implemented across England since 2009. The programme involves cardiovascular risk stratification—at 5-year intervals—of all adults between the ages of 40 and 74 years, excluding any with pre-existing vascular conditions, and offers treatment to those at high risk. However, the cost-effectiveness and equity of population cardiovascular disease screening are contested.
Researchers from the University’s Department of Public Health & Policy, led by Dr Chris Kypridemos and Dr Brendan Collins, aimed to determine whether the programme is cost-effective and equitable in a city with high levels of deprivation and cardiovascular disease such as Liverpool, UK. Liverpool is a city with a high concentration of cardiovascular risk factors and a high burden of cardiovascular disease. Therefore, intuition may suggest that CVD prevention programmes should be very effective.
Synthetic Liverpudlians
As part of the study, the researchers used computers to simulate the life courses of synthetic Liverpudlians under different policy scenarios. They based their simulation on existing data about the area.
This study provides detailed evidence on effectiveness, cost-effectiveness, and equity of health checks while also uniquely providing estimations of the speed at which these programmes will reach these thresholds, and is contributing to the NIHR funded project WORKHORSE, led by Prof O’Flaherty.
The results show that firstly, different implementation structures for health checks may improve cost-effectiveness and equity. Secondly, all these approaches are powerfully enhanced by the addition of population-wide, structural interventions to improve diet (e.g., mandatory salt reformulation of processed foods) or reduce smoking (e.g. by increasing tobacco taxes).
Local decision makers
Dr Chris Kypridemos said: “According to our analysis, the optimal approach to prevention in Liverpool requires a comprehensive package which includes both NHS Health Checks and structural policies that empower people to make healthier choices. A few years ago, Liverpool City Council took the initiative to legislate for a smoke-free city and pave the way for national legislation. Our findings highlight the importance of local leaders to design and implement further such policies.
Prof O’Flaherty added, “This type of user-friendly model for policymakers at the local level will support local decision makers in gaining insights into the local population and hence make better-informed decisions.”
The full study, entitled ‘Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK’, can be found here.